John D Cramer1, Robert L Ferris2, Seungwon Kim3, Umamaheswar Duvvuri3. 1. Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Otolaryngology - Head and Neck Surgery, Wayne State University School of Medicine, Detroit, MI, United States. Electronic address: jdcramer@med.wayne.edu. 2. Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States. 3. Department of Otolaryngology - Head and Neck Surgery, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Abstract
OBJECTIVES: Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). MATERIALS AND METHODS: We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2-4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). RESULTS: We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43-2.08) or CRT (HR 0.96; CI 0.45-2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification. CONCLUSION: We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.
OBJECTIVES:Human papillomavirus-associated (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) is a unique form of head and neck cancer with improved prognosis. We assessed survival for stage I patients with low- or intermediate-risk pathologic features with surgery alone compared with surgery with adjuvant radiation (RT) or chemoradiation (CRT). MATERIALS AND METHODS: We identified patients with stage I HPV+ OPSCC (after restaging with 8th edition staging system) treated with surgery alone, adjuvant RT or CRT in the National Cancer Data Base from 2010 to 2013. We compared survival for low-risk patients (≤1 metastatic lymph nodes with no adverse features) and intermediate-risk patients (2-4 metastatic lymph nodes, microscopic extranodal extension (ENE) or lymphovascular invasion). RESULTS: We examined 1677 patients with median follow-up of 43.9 months. In the intermediate-risk group, 4-year overall survival was 94.0% with surgery alone, 91.5% with adjuvant RT and 92.0% with adjuvant CRT (p = 0.72). There were similar rates of overall survival in the low-risk group. In multivariable models accounting for clinicopathologic differences the dose of adjuvant RT was not associated with mortality. On Cox proportional hazard modeling, adjuvant RT (HR 0.94; CI 0.43-2.08) or CRT (HR 0.96; CI 0.45-2.11) did not significantly improved survival compared with surgery alone in the intermediate-risk group (reference). Similar results were seen in the low-risk group. The composite number of pathologic risk features significantly improved risk stratification. CONCLUSION: We provide observational evidence that adjuvant RT or CRT does not provide a survival benefit for stage I HPV+ OPSCC with low- or intermediate-risk pathologic features.
Authors: Rishabh Sethia; Ali C Yumusakhuylu; Isa Ozbay; Virginia Diavolitsis; Nicole V Brown; Songzhu Zhao; Lai Wei; Matthew Old; Amit Agrawal; Theodoros N Teknos; Enver Ozer Journal: Laryngoscope Date: 2017-08-03 Impact factor: 3.325
Authors: K Kian Ang; Jonathan Harris; Richard Wheeler; Randal Weber; David I Rosenthal; Phuc Felix Nguyen-Tân; William H Westra; Christine H Chung; Richard C Jordan; Charles Lu; Harold Kim; Rita Axelrod; C Craig Silverman; Kevin P Redmond; Maura L Gillison Journal: N Engl J Med Date: 2010-06-07 Impact factor: 91.245
Authors: David M Routman; Ryan K Funk; Kanograt Tangsriwong; Alexander Lin; Michael G Keeney; Joaquín J García; Matthew A Zarka; Jason T Lewis; David G Stoddard; Eric J Moore; Courtney N Day; Qihui Zhai; Katharine A Price; John N Lukens; Samuel Swisher-McClure; Gregory S Weinstein; Bert W O'Malley; Robert L Foote; Daniel J Ma Journal: Int J Radiat Oncol Biol Phys Date: 2017-06-28 Impact factor: 7.038
Authors: Jacques Bernier; Jay S Cooper; T F Pajak; M van Glabbeke; J Bourhis; Arlene Forastiere; Esat Mahmut Ozsahin; John R Jacobs; J Jassem; Kie-Kian Ang; J L Lefèbvre Journal: Head Neck Date: 2005-10 Impact factor: 3.147
Authors: Gypsyamber D'Souza; Aimee R Kreimer; Raphael Viscidi; Michael Pawlita; Carole Fakhry; Wayne M Koch; William H Westra; Maura L Gillison Journal: N Engl J Med Date: 2007-05-10 Impact factor: 91.245
Authors: D C Ling; B V Chapman; J Kim; G W Choby; P Kabolizadeh; D A Clump; R L Ferris; S Kim; S Beriwal; D E Heron; U Duvvuri Journal: Oral Oncol Date: 2016-08-25 Impact factor: 5.337
Authors: William G Albergotti; Hannah L Schwarzbach; Shira Abberbock; Robert L Ferris; Jonas T Johnson; Umamaheswar Duvvuri; Seungwon Kim Journal: JAMA Otolaryngol Head Neck Surg Date: 2017-12-01 Impact factor: 6.223
Authors: Shayan Cheraghlou; Phoebe K Yu; Michael D Otremba; Henry S Park; Aarti Bhatia; Cheryl K Zogg; Saral Mehra; Wendell G Yarbrough; Benjamin L Judson Journal: Cancer Date: 2017-12-15 Impact factor: 6.860
Authors: Brett A Miles; Marshall R Posner; Vishal Gupta; Marita S Teng; Richard L Bakst; Mike Yao; Kryzsztof J Misiukiewicz; Raymond L Chai; Sonam Sharma; William H Westra; Seunghee Kim-Schulze; Bheesham Dayal; Stanislaw Sobotka; Andrew G Sikora; Peter M Som; Eric M Genden Journal: Oncologist Date: 2021-03-18
Authors: Giuseppe Meccariello; Andrea Catalano; Giovanni Cammaroto; Giannicola Iannella; Claudio Vicini; Sheng-Po Hao; Andrea De Vito Journal: Medicina (Kaunas) Date: 2022-08-04 Impact factor: 2.948
Authors: Timon Hussain; Kruthika Thangavelu; Cornelius Kürten; Lisa Galland; Benedikt Höing; Eric Deuss; Stefan Mattheis; Stephan Lang; Cornelius Deuschl; Michael Forsting; Nils Dörner Journal: Eur Arch Otorhinolaryngol Date: 2022-07-04 Impact factor: 3.236
Authors: Xinyi Liu; Ping Liu; Rebecca D Chernock; Zhenming Yang; Krystle A Lang Kuhs; James S Lewis; Jingqin Luo; Hua Li; Hiram A Gay; Wade L Thorstad; Xiaowei Wang Journal: J Natl Cancer Inst Date: 2021-06-01 Impact factor: 13.506